Abstract
ObjectivesWith the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004–2018.MethodsCoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality).Results14,876 individuals were included. Overall, LP prevalence in 2004–2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08).ConclusionsLP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
Highlights
Late presentation (LP) was defined as HIV diagnosis with CD4 count 350 cells/μL or an AIDS defining event (ADE)
Late presentation (LP) of HIV infection represents an important barrier in achieving the UNAIDS goals to end AIDS epidemic by 2030
Incidence rates for the composite endpoint, the first ADE, the first serious non-AIDS events (SNAE) and death from any cause were calculated as the number of new cases occurred after six months from enrolment divided by the total person-years at risk from six months after enrolment until the first event, last follow-up visit or death, whichever came first
Summary
Late presentation (LP) of HIV infection represents an important barrier in achieving the UNAIDS goals to end AIDS epidemic by 2030. According to the last treatment cascade estimates [6], 13% of people living with HIV in Spain are unaware of it. Of those diagnosed, 97.3% were on ART, of whom 90.4% had an undetectable viral load. In 2014 the Spanish Ministry of Health published national guidelines for promoting early HIV diagnosis [7]. They recommended offering HIV testing when there is an in case of indication or clinical suspicion of HIV infection or AIDS and recommended routine offer of HIV screening. There is no information on whether the implementation of these guidelines have had an impact on LP prevalence
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